Racial and Ethnic Disparities in Functioning at Discharge and Follow-Up Among Patients With Motor Complete Spinal Cord Injury

Abstract

Objective To examine racial and ethnic differences in self-care and mobility outcomes for persons with a motor complete, traumatic spinal cord injury (SCI) at discharge and 1-year follow-up. Design Retrospective cohort study. Setting Sixteen rehabilitation centers contributing to the Spinal Cord Injury Model Systems (SCIMS) database. Participants Adults with traumatic, motor complete SCI (N=1766; American Spinal Injury Association Impairment Scale grade A or B) enrolled in the SCIMS between 2000 and 2011. Selected cases had complete self-reported data on race and ethnicity (non-Hispanic white, non-Hispanic black, or Hispanic) and motor FIM scores assessed at inpatient rehabilitation admission, discharge, and 1-year follow-up. Interventions Not applicable. Main Outcome Measures Functional outcomes were measured by FIM self-care and mobility scores on a 1 to 7 FIM scale, at discharge and 1-year follow-up. Results Multiple regression models stratified by neurologic category and adjusted for sociodemographic and injury characteristics assessed racial and ethnic group differences in FIM self-care and mobility change scores at discharge and 1-year follow-up. At discharge, non-Hispanic black participants with tetraplegia and paraplegia had significantly poorer gains in FIM self-care and mobility scores relative to non-Hispanic white and Hispanic participants. At 1-year follow-up, similar FIM self-care and mobility change scores were found across racial and ethnic groups within each neurologic category. Conclusions Non-Hispanic white and Hispanic participants had comparatively more improvement in self-care and mobility during inpatient rehabilitation compared with non-Hispanic black participants. At 1-year follow-up, no differences in self-care and mobility outcomes were observed across racial and ethnic groups. Additional research is needed to identify potential modifiable factors that may contribute to racially and ethnically different patterns of functional outcomes observed during inpatient rehabilitation.

Epidemiology of Spinal Cord Injury in Bangladesh: A Five Year Observation from a Rehabilitation Center

“…Male predominance previously reported in both local [2,3,5,14] and global [1,3,4,8,9,10] studies were also found in this research where 86.8% (n=1897) were male and 13.1% (n=287) were female. Distribution of age in this study showed more people in their 2 nd decade and 3 rd decade was vulnerable to spinal cord injury which was different from Hossain et al where the mean age was 47.44 [17] and Ulrich et al who found the mean age to be 36.1 [18].…”

“…Spinal Cord injury, whether traumatic or non-traumatic, is a sudden [1], devastating and debilitating [2][3][4] neurological condition [5] addressed throughout the history [5,6]. The incidence of spinal cord injury is increasing with time with an annual rate of 15-40 cases per million [2,5,7] with male predominance and a propensity of affecting the low-socio economic group [2].…”

How Are Race, Cultural, and Psychosocial Factors Associated With Outcomes in Veterans With Spinal Cord Injury?

“…2–7 Racial and ethnic minorities also have an increased risk of secondary complications (e.g., pain, pressure ulcers) and poorer self-care ability as compared to whites (WH). 5, 8–12 Similarly, previous studies have found higher rates of depressive symptomatology and lower rates of post-injury employment among minority wheelchair users with SCI, as compared to their WH counterparts. Further, WH versus minority race differences in pain severity and pain interference were significantly associated with differences in subjective wellbeing.…”

Psychosocial aspects of spinal cord injury pain: a meta-analysis

“…Indeed, research suggests that there is variability in degree of SCI pain interference among various racial groups, with non-whites tending to report more severe pain than whites. 67 Similarly, it was not possible to compare SCI pain and no pain groups on potential aetiological variables that may contribute to pain (e.g. gender, marital status, injury severity, psychological morbidity) 6,65,66 as studies did not consistently report these data for pain subgroups.…”